曲唑酮联合百乐眠通过PI3K-AKT信号通路改善老年人慢性失眠伴焦虑抑郁症状的研究  

A study on the improvement of chronic insomnia with anxiety and depression through PI3K-AKT signaling pathway by trazodone combined with bermian

作　　者：黄攀登[1] 董利平[1] 傅银银 张友涛 谷伟[1] 高云鹰[1] 崔玉环[1] 赵宝民[1] HUANG Pan-deng;DONG Li-ping;FU Yin-yin(Department of Geriatrics,The First Affiliated Hospital of Hebei North University,Zhangjiakou Hebei 075000,China)

机构地区：[1]河北北方学院附属第一医院老年病科,河北张家口075000

出　　处：《临床和实验医学杂志》2023年第3期266-270,共5页Journal of Clinical and Experimental Medicine

基　　金：河北省医学科学研究重点课题计划(编号:20200551)。

摘　　要：目的研究曲唑酮联合百乐眠通过磷脂酰肌醇3激酶(PI3K)-蛋白激活酶B(AKT)信号通路对老年人慢性失眠伴焦虑抑郁症状的影响。方法前瞻性选取2018年4月至2020年1月河北北方学院附属第一医院收治的138例老年人慢性失眠伴焦虑抑郁症患者,按随机数字表法将其分为对照组和观察组,各69例。对照组口服曲唑酮50 mg/d,观察组在对照组基础上口服百乐眠胶囊2次/d,两组均治疗2个月。比较两组患者各因子表达差异;评估两组患者临床治疗效果;分别于治疗前及治疗2个月后,采用匹兹堡睡眠指数(PSQI)评估受试者睡眠质量;采用汉密尔顿抑郁量表(HAMD)评估患者抑郁情况;采用汉密尔顿焦虑量表(HAMA)评估患者焦虑情况。采用酶联免疫吸附试验测定患者血清中肿瘤坏死因子α(TNF-α)和白细胞介素-1β(IL-1β)含量;采用蛋白免疫印迹法测定患者外周血单个核细胞中PI3K、AKT和pAKT蛋白表达量;采用荧光定量PCR法测定患者外周血单个核细胞中PI3K和AKT mRNA含量;观察并记录受试者治疗期间不良反应发生情况。结果观察组临床治疗总有效率为94.20%,明显高于对照组(71.01%),差异有统计学意义(P<0.05)。治疗2个月后,两组患者PSQI、HAMD和HAMA量表评分均较治疗前明显降低,且观察组较对照组降低更显著,差异均有统计学意义(P<0.05)。治疗2个月后,两组患者TNF-α和IL-1β水平均较治疗前明显降低,且观察组患者TNF-α和IL-1β水平较对照组降低更显著,差异均有统计学意义(P<0.05)。患者PSQI、HAMD和HAMA量表评分与信号通路中因子TNF-α和IL-1β均呈正相关(r=0.443、0.447、0.508;r=0.478、0.472、0.492,P<0.05)。治疗2个月后,两组患者PI3K、AKT、pAKT蛋白以及PI3K mRNA和AKT mRNA均较治疗前降低,且观察组均明显低于对照组,差异均有统计学意义(P<0.05)。观察组不良反应发生率为11.60%,明显低于对照组(28.99%),差异有统计学意义(P<0.05)。结论曲Objective To study the effects of trazodone combined with bermian on chronic insomnia with anxiety and depression through phosphatei-dylinositol 3 kinase(PI3K)-serine-threonine kinase(AKT)signaling pathway.Methods A total of 138 patients with chronic insomnia and anxiety depression treated in the First Affiliated Hospital of Hebei North University from April 2018 to January 2020 were randomly divided into control group and observation group,69 cases in each group.The control group was treated with trazodone for 50 mg/d,and the observation group was treated with bailomian capsule on the basis of the control group for 2 times/d,both groups were treated for 2 months.The differences of factors expression between patients and healthy subjects were compared;the clinical effect of two groups was evaluated;Before treatment and 2 months after treatment,Pittsburgh Sleep Index(PSQI)was used to evaluate the sleep quality;Hamilton Depression scale(HAMD)was used to evaluate the depression;Hamilton anxiety scale(HAMA)was used to evaluate the anxiety;the content of tumor necrosis factor alpha(TNF-α)and interleukin-1β(IL-1β)in serum was determined by enzyme linked immunosorbent assay;the expression of PI3K,AKT and pAKT protein in peripheral blood mononuclear cells was determined by Western blotting;the content of PI3K and AKT mRNA in peripheral blood mononuclear cells was determined by fluorescence quantitative PCR method;the occurrence of adverse reactions during treatment was observed and recorded.Results A total effective rate of the observation group was 94.20%,which was significantly higher than that in the control group(71.01%),the difference was statistically significant(P<0.05).After 2 months of treatment,the scores of PSQI,HAMD and HAMA scales in the two groups were significantly lower than those before treatment,and the scores in the observation group were significantly lower than those in the control group,the differences were statistically significant(P<0.05).After 2 months of treatment,the levels of TNF-αand IL-1

关 键 词：曲唑酮 百乐眠 PI3K-AKT 失眠 焦虑 抑郁 

分 类 号：R740[医药卫生—神经病学与精神病学] R749[医药卫生—临床医学]